Dying to Live: The Power of Transcendence in the Treatment of Existential Anxiety

In Western society, death is a taboo subject and, from the perspective of medical science, is viewed as a defeat and a failure. Medicine is excellent at keeping people alive but is a great deal poorer when it comes to easing the passage of the dying. In a sense, society has actually regressed in terms of the integration of death and dying, as medical science has grown in power and death has become a less common part of our lives. Existential anxiety, which includes fear and anxiety centered on death and dying, is something  often overlooked and there is a notable lack of effective treatments or  therapies, with physicians likely to feel  underequipped in treating the psycho-spiritual effects of death anxiety (1, 2).

Despite the lack of currently integrated treatments, there are a number of avenues worthy of much more attention in this regard. Chief among them are the classical psychedelics, a group of substances long-used by humans in the context of healing and divination, which are currently experiencing a scientific research renaissance. Psychedelics may have a unique utility in their potential efficacy in the treatment of existential anxiety. While current research has focused on terminally ill patients, with respect to life we are all terminal, and it may likely be that the benefits of these substances are too important to limit to the treatment of sick people only, although this should be made a priority.

Aldous Huxley was a pioneer of this approach of using psychedelics for treatment of the dying, writing to pioneering psychedelic researcher Dr. Humphry Osmond in 1958  about  how lysergic acid diethylamide (LSD) could be used to treat terminal cancer patients so  their dying could be  a “more spiritual, less  strictly physiological process” (3). A few  years later when Huxley—a man who talked the talk and walked the walk—lay dying from laryngeal cancer, he requested and received two  100µg dose injections of LSD from his wife Laura, who reported that his death was extremely beautiful and  serene  in  a  letter  she   wrote in 1963 to Aldous’s brother Julian (4).

A pioneering researcher and proponent of using psychedelics to treat the terminally ill was Dr. Walter Pahnke. Pahnke joined the Maryland Psychiatric Research Center in 1967 and conducted psychedelic therapy with LSD and N,N-dipropyltryptamine (DPT) until his untimely death in 1971 (5).  He used LSD in the treatment of terminal cancer patients and wrote a number papers and book chapters with colleagues on his research findings during this time. One  chapter published in  Psi  and altered states of  consciousness:  Proceedings of  an  International Conference on  Hypnosis, Drugs, Dreams, and  Psi looked at the effect of the mystical-type experience on  terminal cancer patients and the potential implications  for psi research (6). A paper published in the Journal of Psychedelic Drugs explored psychedelic therapy utilizing LSD with terminal cancer patients (7). As in the case of Huxley, Pahnke was motivated in  part by  his own personal mystical-type experiences catalyzed through his own psychedelic usage (8).

In  central  Africa, the  oneirogenic  (‘dream-inducing’)  plant Tabernanthe iboga  has a long  history of  use as a spiritual sacrament and medicine and is employed by  a number of  different groups such as the Bwiti  in religious ceremonies. The Bwiti  utilize a single large initiatory dose of  the iboga plant, in  the form of  ingested root bark, consumed by  the initiate to  induce radical spiritual growth. This  induces an experience resembling a near-death experience (NDE) in which the initiate is instructed to go beyond the body to the spiritual realms to seek guidance and insight on life issues via communing with their ancestors (9).

A number of recent studies have demonstrated both the safety and efficacy  of  classical  psychedelics such as LSD and psilocybin in the treatment of  existential anxiety and depression in the terminally ill.  A pioneering pilot study by Grob et al. (2011) with psilocybin using a dose of 0.2 mg/kg reported safe physiological and psychological responses and no clinically adverse events. A reduction in anxiety was noted 1-3 months after treatment, with a long-term improvement in mood observed at six months (10).  A study by Gasser et al. (2014) using LSD (at a dose of 200 µg) as a treatment for the anxiety associated with life-threatening diseases reported no lasting adverse reactions from LSD administration, long-term benefits sustained over a 12-month period following a single dose, and highly significant reductions in anxiety (in 77.8% of patients) and a rise in quality of life (in 66.7% of patients) (11).

Larger scale studies using psilocybin in the treatment of anxiety and depression suffered by  patients with life-threatening cancer have built on this previous research. One study conducted by Griffiths et al. (2016)  at Johns Hopkins University using doses of 22 and 30 mg/70 kg found that 80% of patients reported lower depression and anxiety at a six-month follow-up including reduced death anxiety and increased quality of life, life meaning, and optimism. Study participants reported improved attitudes towards life and self and improved mood, relationships, and spirituality with over 80% of  participants describing greater well-being  and life satisfaction.  It is notable that the mystical-type experiences occurring through psilocybin treatment   mediated   the   long-term   therapeutic   outcomes (12).  A study conducted by Ross et al. (2016) at New  York  University  utilizing  a psilocybin dose of 0.3 mg/kg reported  similar   results,   with   study participants  reporting immediate, substantial,  and  sustained  improvements in  anxiety and depression, with decreases in  cancer-related demoralization and hopelessness, improved spiritual well-being, and increased  quality  of   life.   Enduring  clinically significant reductions in anxiety, sustained reductions in  existential distress, increased  quality of life,  and an improved attitude towards death were each reported by a majority of participants.  Again, it was noted that the psilocybin-catalyzed mystical experience mediated the long-term therapeutic effect on anxiety and depression (13).

It can be  seen from these studies that the mystical-type experiences reliably catalyzed through  high-dose  psilocybin are a core part of  their long-term  therapeutic  effect on  depression  and  anxiety  ratings,  while enhancing  life   meaning  and  outlook. It seems, too, that  the  mystical experience is of great importance with regard to altering perceptions of death and reducing death anxiety. Facets of the mystical experience such as the sense of  unity, perceived interconnectedness of all things, a deep sense of  love, reverence,  sacredness,  and  noetic quality  are very likely contributing to the uplifting attitudinal shifts towards death but also towards self,  life,  and others. A recently published study by Griffiths et al.  (2017) utilizing  high  doses  of 20  mg and 30 mg/70 kg psilocybin found that  mystical  experiences in synergy with spiritual practices produced large significant positive changes for a number of trait measures of prosocial attitudes, behaviors, and perspectives, among them death transcendence (14). This study is notable in that unlike all the aforementioned studies, study participants were physically and mentally healthy and not terminally ill.  However, significant numbers  of  these participants reported  death transcendence under  high-dose  psilocybin, suggesting that such a shift in perspective is something intrinsic to  this experience.

Medicine and  psychiatry  operate  under  the  paradigm  of   drugs affecting patients for the duration of  time they are in  a patient’s system. The  research described here demonstrates that a single dose of a classical psychedelic like psilocybin administered in a psychotherapeutic setting can produce highly beneficial long-term psychotherapeutic   effects,  lasting months to  a year or  more. This  is  an entirely novel, unprecedented, and potentially revolutionary finding which currently lacks a clear scientific explanation.

Treatment of  rational suicide in  the elderly is  another unexplored frontier  where  psychedelics could hold promise. Rational suicide can be defined as suicide of the elderly to escape suffering or due to a weariness of living due to age-related losses. Psychedelic experiences in a psychotherapeutic context may help foster a sense of life-meaning and positive outlook and promote the perception that life is worth living, even in conditions of great adversity (15).

The  mystical or  transcendent experience catalyzed through psychedelics seems to be  a key  part of their long-term therapeutic efficacy and  to   be   strongly  linked  to   the  reduction  of death anxiety. These experiences may allow patients to experience a sense of connectedness to the sacred, to  enhance relationships with family and loved ones, to  live fully  in   the  moment  with  equanimity,  and  to  make the  most of  their remaining   time.  Through their experience with the psychedelic, individuals may be  able to transcend their primary identification with their physical bodies and experience ego-free states, or ego death, which in turn may generate a new perspective and acceptance. It seems likely this facet of the psychedelic-induced mystical experience is  a key  factor linked to a long- term reduction in death anxiety. In the recent psilocybin studies described above, it was also noted that encounters with death or dying were common in  people’s experiences. Such experiences would vary widely in content between different individuals, with some feeling their consciousness as something separate from their physical body that will survive its demise (16).

Whether the experiences reported by study participants are valid or illusionary is  of  secondary importance to the psychotherapeutic benefits these experiences have for the experiencer in question. To paraphrase pioneering psychologist and philosopher William James in his seminal book The Varieties of Religious Experience the value of mystical experiences can only be judged “by their fruits” not “by their roots” (17). Furthermore, the psychological symptoms of existential distress share a great deal of overlap with those of a hyperactive default-mode network, a part of the brain that psilocybin is known to quiet (18).

Psilocybin may be particularly well  suited for use in palliative care scenarios. It doesn’t carry the same political or cultural baggage of LSD and is shorter acting than the  latter with less chance of  yielding  adverse reactions. It is non-toxic, physiologically well tolerated, and suitable for use by the terminally ill (19).  In  the future, it could be administered in family groups in a supportive setting. Psilocybin is used in family settings by indigenous groups such as the Mazatec in Mexico (20) and, due to psilocybin’s ability to lower psychological armor and facilitate communication, it could be an excellent catalyst for family groups to connect and say their goodbyes to loved ones with an openness that may otherwise not be easily accessible.

The psychedelic compound 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) has received very little scientific research attention at the present time. It may, however, be  well  suited to treating death anxiety. 5- MeO-DMT treatment-provider Dr. Geraldo “Gerry” Ruben Sandoval Isaac conducted a 10-year retrospective study with 1,699  participants and noted that  85%   reported  a  mystical or  religious  experience  and  that  60% experienced some form of  dying or  death (21). This is twice the 30%  reported in  the Johns Hopkins psilocybin trials of  study participants reporting profound experiences of their own death. This is a notable result, as it  can be seen from the aforementioned psilocybin research that the mystical experience that psychedelics can catalyze is a core component of their long-term  psychotherapeutic effect in the treatment of existential anxiety. In addition, a simulated or  hallucinatory experience of  death or dying can be  highly cathartic with regard to people’s death  anxiety. This study is suggestive that 5-MeO-DMT can induce both experiences with high levels of consistency, so  it may be  that this compound is particularly well suited for the treatment of death anxiety. The phenomenological effects of 5-MeO-DMT are somewhat atypical in comparison to other classical psychedelics and seem to  more closely resemble NDEs in experiential content (22).  Luke and Kittenis (2005) found that reported death-related experiences (death, rebirth, or memory of a past life) tended to   be more commonly associated with 5-MeO-DMT than any other substance (23).

5-MeO-DMT  is  a great deal more powerful than the other classical psychedelics such as psilocybin and LSD, so  it  requires careful handling, and  session preparation and  integration will be   highly  important  to maximize experiential benefits. However, the experience is a great deal shorter than that yielded by the other psychedelics like  psilocybin or  LSD, so it would be much less taxing on treatment providers’ time.

During a  program  of psychedelic therapy  with  terminal  cancer patients  conducted by  Dr. Stanislav Grof at the Maryland Psychiatric Research Center in Baltimore, a number of patients reported NDEs as their diseases progressed, and they reported their prior psychedelic experiences as being very similar to  their NDEs  and being an invaluable experiential training  for dying (24).   Both  NDEs  and psychedelics share a capacity for being able to  change human personality in  the long-term following an experience. This quantum change (25) in personality yielded by experiences catalyzed via NDEs and psychedelics are distinct from one another but also share some interesting overlap. The personality changes yielded by  a classic NDE can be considered as being deeper, more comprehensive, and more robust than those yielded by  psychedelics such as psilocybin which tend to  be  more specific, in particular affecting  the  personality  domain of openness (26). Openness includes a hunger for knowledge, and this, too, has been highlighted by experiencers of NDEs (NDErs)   as a long-term effect of their experiences (27).  An increase in well-being,  life   satisfaction,  and  sense  of   life-purpose  or meaning  are also commonly reported  after-effects  of   both  NDEs   and psychedelic-induced  mystical experiences (28), and a negative relation between purpose in  life  and death anxiety has also been observed (29).

An interesting  property  of NDEs is that simply learning about them can promote psycho-spiritual  benefits and result in  changes of  outlook regarding death in  people without direct experience of  one similar to an NDEr.  Learning about NDEs through reading or hearing about them can result in such changes, but direct testimony from an NDEr seems to be the most powerful medium of transformation. A number of  NDE researchers have noted such changes in  outlook themselves, with Dr. Kenneth Ring being one of  the pioneering NDE researchers who first noted this phenomenon, describing it as a “benign virus” in reference to it being positively psychologically contagious (30).  A number of  independent studies such as those by  Rominger (2009)  and Tassell-Matamua et al. (2016) have further validated the existence of  this interesting psychological phenomenon,  and found that while it occurs in those at high risk of death, such as the terminally ill and those with suicidal ideation, it also occurs among  clinically healthy  populations (31, 32).  Thus, in learning about the NDE and people’s experiences, one can reap  much of the benefit of the experience without the inherent risk of being near death.

A core component of the NDE is the out-of-body experience (OBE). A common anecdotal side effect of  OBEs is that people lose their fear of death, something noted by pioneering OBE explorer Robert Monroe in his book Journeys Out of  the Body (1971) and  others (33). Even a virtual OBE induced via virtual reality (VR) technology is capable of reducing death anxiety (34).  This further suggests that  it  is  the  experience  of   being disembodied and  transcending  the primary identification with the physical body that is a common link  and a core experiential and psychotherapeutic component shared by the OBE, NDE, and psychedelic experience and likely an integral part of its  efficacy in reducing death anxiety. Moreover, there  seems to  be  a great deal of reported phenomenological overlap between NDEs and OBEs in particular. Unlike the  obvious risks  involved in  the generation of NDEs  and the illegality of psychedelics, OBEs can, with practice, be induced voluntarily and safely.

As an aside to  psychedelic therapy, NDEs,   and OBEs,  other consciousness practices such as holotropic breathwork have been found to reduce death anxiety (35). Holotropic breathwork is an  effective alternative  and  legal means  of accessing transpersonal states that may have useful applications for the treatment of  existential  anxiety. Mindfulness meditation may also have potential in alleviating existential anxiety, with a mindful outlook showing efficacy in its ability to neutralize fears of death and dying (36).

It can be seen that there are a number of interesting avenues that warrant further attention in relation to direct experiences, consciousness-related practices, and simply learning about these experiences from others. Given that death is  something shared  by   all, and  given that it is an unavoidable and inevitable part of our lives,  it seems there could be  great potential benefit in giving these experiences the attention they deserve. It seems that these various experiences may all lessen death anxiety, but the benefits may transcend this alone. A simulated dying event before one’s actual dying may serve not only to reduce death anxiety but also act to reinforce one’s life priorities in a positive fashion while alive.

This article was originally published in Threshold: Journal of Interdisciplinary Consciousness Studies:

Gandy, S. (2017). Dying to live: The power of transcendence in the treatment of existential anxiety. Threshold: Journal Of Interdisciplinary Consciousness Studies, 1(2), 25-36.

Retrieved from http://tjics.org/index.php/TJICS/article/view/14

Breaking Convention 2017

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Research and Theory for Nursing Practice, 23(1), 23–41. doi:10.1891/1541-6577.23.1.23

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